Rising Cost Of Doing Business Is Driving Doctors Out

House Calls

August 11, 2002|By Dr. Richard T. Bosshardt, Sentinel Correspondent

Question: During a recent office visit, my doctor's receptionist told me that he may soon have to quit practice because of malpractice and something called HIPAA. He is an excellent doctor, and I would hate to have to find someone else. Can you explain what she meant?

Answer: For years physicians, and many non-physicians, have been concerned about spiraling malpractice premiums, frivolous lawsuits and exorbitant judgments. Recently, one of the largest providers of malpractice insurance in the nation pulled out of this field, leaving thousands of doctors scrambling to find a new insurer. Premiums have skyrocketed. Many doctors settle defensible lawsuits rather than have to go to court and lose time from practice, and to avoid the adverse publicity that accompanies a lawsuit. No solutions have been forthcoming despite years of talk about tort reform.

One example may give an idea of the impact of this problem. I know of a general surgeon with no lawsuits against him whose malpractice premium is more than $80,000 per year and who may have to quit practice as a result. He sees a large proportion of Medicare patients and treats many patients with no insurance who come in through the emergency room. He works nearly three months of the year to pay this premium and could not pay himself for the last several weeks of the year.

One can argue endlessly whether doctors are overpaid or not, but in fact, the average income for physicians has been declining for years. Reimbursement for medical care and surgery from insurance companies and government agencies, such as Medicare, has steadily declined whereas the cost of practicing medicine has risen rapidly. It is only a matter of time before it becomes too expensive to practice.

Right now there are hospitals in Central Florida that cannot offer general surgery services, or have severely limited operating time because surgeons are leaving or quitting practice. Many physicians in all specialties are leaving the state or leaving medicine altogether. This problem is only going to get worse.

HIPAA stands for Health Insurance Portability and Accountability Act of 1996, the result of the Clinton administration's efforts to reform health care. HIPAA regulations deal with three aspects of health care: electronic data submission, privacy and security. The goals of HIPAA are to ensure that health insurance can be transferred from job to job, reduce fraud and abuse, enforce standards for health information and guarantee the privacy and security of health information -- all laudable goals. The problem will be implementation. Space does not permit an exhaustive discussion so I will offer a few concerns.

The health-care consulting group recently estimated that implementation of HIPAA regulations will cost more than $66 billion, more than Y2K changes cost medicine, and this does not include ongoing compliance training and monitoring once implemented. No provisions have been made for recovery of these costs to private offices, hospitals and other medical institutions. HIPAA compliance will add a level of bureaucracy to offices already buried in mandatory paperwork, with the threat of large fines, and even possible criminal prosecution, for noncompliance.

Protection of privacy of patients' medical information, particularly when electronically submitted, poses challenges that will tax many institutions.

Absolute security in data transmission is the goal, but the technology does not exist for this.

Some experts predict that many offices, and even some hospitals, will have to close as a result of not being able to meet HIPAA requirements.

Already, a huge cottage industry has evolved marketing products and services to help doctors, hospitals, etc. to achieve HIPAA compliance. As occurred with Y2K, many of these products and services are bogus, unnecessary or offered at inflated prices.

The push for HIPAA compliance, coming on the heels of the current malpractice crisis, has been a double whammy for doctors.

Physicians have no choice but to adapt or find another profession. Many older, experienced physicians are throwing in the towel and retiring early.